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Dantrolene for Malignant Hyperthermia 848th FST

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Title: Dantrolene for Malignant Hyperthermia 848th FST


1
Dantrolene for Malignant Hyperthermia848th FST
2
DantroleneDantrium Sodium
  • Calcium channel blocker commonly used for
    treatment and pretreatment of Malignant
    Hyperthermia

3
Dantrolene
  • The agent of choice for treatment of malignant
    hyperthermia (MH)
  • It acts directly on the contractile mechanism of
    skeletal muscles by interfering with release of
    calcium by the sarcoplasmic reticulum

4
Dantrolene Reactions
  • The most serious reaction has been with oral
    administration and a related hepatotoxicity
  • Prolonged high doses have been associated with
    hepatic necrosis
  • In all cases normal liver function returned after
    discontinuation of the drug

5
Dantrolene common side effects
  • Dizziness
  • Diplopia
  • Dysarthria
  • Sensation of swelling of the eyeballs and tongue
  • Feeling that limb muscles are rubbery
    spaghetti-like and weak
  • Decreased proprioception of feet while climbing
    or descending steps
  • Nausea, epigastric discomfort, and diarrhea
  • Side effects subside within a few days

6
Dantrolene
  • Marketed in a freeze dried form and must be
    reconstituted with sterile water
  • Treatment of MH is by rapid I.V. push of the drug
  • Dosage is 1mg/kg and continuing until symptoms
    have begun to subsides
  • Temperature begins to fall
  • Muscle stiffness begins to subside
  • Heart rate begins to decrease
  • Or to a maximal dose of 10 mg/kg

7
Maintenance
  • If symptoms return, previous dosage can be
    repeated every 15 minutes
  • Even in absence of recurrence of symptoms,
    loading dose(s) should be followed by infusion of
    1 to 2 mg/kg during each 3 to 4 hour period until
    all evidence of active MH crisis has subsided

8
Oral Dantrolene
  • Used extensively in pre-treatment of susceptible
    MH patients
  • Recommended dosage is 4 mg/kg for 24 to 48 hours
    prior to surgery
  • Some clinicians do not use Dantrolene
    prophylacticlly

9
References
  • Stene, J. K., Grande, C.M. Trauma Anesthesia.
    Williams Wilkins, 1991, Baltimore, Maryland.

10
Questions
Jim Malson, CPT
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